Introduction
Auditory brainstem response using click stimuli enable global objective estimation of hearing threshold. Recently, it has been suggested that a chirp stimulus may produce a synchronous response from a large portion of basilar membrane. The chirp was designed to produce simultaneous displacement maxima along the cochlear partition by compensating for frequency-dependent traveling-time differences.
Material and methods
In this study, response characteristic of both click and chirp stimuli are compared in children. We compared latency and amplitude of wave V at different intensity levels and waves I and III at high level.
Results and conclusion
Results show that wave V on using chirp stimuli could be detected easier with shorted in latency and larger in amplitude than in click auditory brainstem response. However, click stimulus was better than chirp stimulus at high-intensity levels with respect to the identification of waves I and III.

Introduction
Hepatocellular carcinoma (HCC) is a primary tumor of the liver, which usually develops in the setting of chronic liver disease, particularly in patients with chronic hepatitis B and hepatitis C. Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment of Barcelona Clinic Liver Cancer-B patients. The aim of this work is to compare the efficacy, safety, feasibility, and cost-effectiveness of drug-eluting bead (DEB)-TACE versus combined conventional transarterial chemoembolization (c-TACE)+percutaneous ethanol injection (PEI) for improving the outcome of large HCC.
Patients and methods
In all, 75 patients with large HCC were included in this study: 30 patients were treated by combined c-TACE + PEI and 45 patients were treated by DEB-TACE.
Results
By comparison of the results of the combined c-TACE + PEI group with the DEB-TACE group, there was no significant difference in tumor response, with better results in the combined c-TACE + PEI group and significant decrease in the median value of the serum level of α-fetoprotein after treatment among patients treated with combined c-TACE + PEI (P = 0.004), and a statistically significant difference in the median value after treatment between the two groups (P = 0.036).
Conclusion
Results of combined c-TACE + PEI and DEB-TACE are comparable, but the cost of a DEB-TACE session is three times that of c-TACE + PEI, and thus cost-effectiveness analyses recommend the use of combined c-TACE + PEI (less cost) in the treatment of large HCC; in addition, there was a significant reduction in the level of α-fetoprotein after combined c-TACE+PEI treatment.

Purpose
The aim of this study was to compare the visual and refractive outcomes of wavefront optimized (WFO) ablations with wavefront guided (WFG) ablations in patients with myopia and myopic astigmatism.
Patients and methods
Two consecutive groups of eyes were treated for myopia and myopic astigmatism with laser insitu keratomileusis. One group was treated with WFO ablation, and the other group was treated with WFG ablation. Refractive evaluation (efficacy, safety, predictability, accuracy, stability, and refractive astigmatism), higher-order aberrations (HOAs), and contrast sensitivity were analyzed preoperatively and at 1, 3, and 6 months postoperatively.
Results
The WFO ablation group comprised 20 eyes of 11 patients who showed a change in the mean spherical equivalent refraction from − 3.34 ± 1.64 D preoperatively to − 0.21 ± 0.30 D at 6 months postoperatively, and the WFG ablation group comprised 34 eyes of 17 patients who showed a change in the mean spherical equivalent refraction from − 3.54 ± 1.50 D preoperatively to − 0.23 ± 0.57 D at 6 months postoperatively. A statistically significant difference was found when comparing within the group preoperatively versus 6 months postoperatively as regards contrast sensitivity, HOAs, trefoil root mean square (RMS), and spherical aberration. However, there was no significant difference in induced coma and spherical aberration RMS within each group preoperatively and at 6 months postoperatively. A statistically significant difference was found when comparing the two groups at 6 months postoperatively with respect to contrast sensitivity, induced HOA RMS, induced trefoil RMS, and spherical aberration. There was no significant difference between the two groups, except for induced coma and spherical aberration RMS.
Conclusion
Both the WFG group and the WFO showed comparable accuracy, efficacy, and safety with nearly equal induction of all HOAs.

Background
Repeated access to the circulation is essential to perform adequate maintenance hemodialysis. Dysfunction of fistulas is the most common reason for secondary intervention and recurrent hospitalization.
Aim
The aim of this study was to report our experience regarding incidence, diagnosis, and different modalities of treatment of complications of arteriovenous fistula.
Patients and methods
This study was conducted prospectively on 239 end-stage renal disease patients who presented to the Department of Vascular Surgery of Assiut University Hospital with complicated arteriovenous (AV) accesses from January 2014 to January 2015. All patients underwent detailed history taking, and data were collected on age, sex, cardiovascular risk factors, history of previous accesses, and any complications that developed since the use of the access. Patients were further evaluated using clinical examination, duplex ultrasound, and fistulography if needed.
Results
There were 137 (42.7%) males and 102 (42.7%) females with a mean age of 57 ± 4 years. Hypertension was the risk factor in 103 (43.1%) patients, whereas diabetes mellitus was present in 45 patients. Of the 239 patients, 57 (23.8%) presented with infected AV access, 42 (17.6%) with thrombosed AV accesses, 33 (13.8%) with bleeding, and 31 (12.9%) with pseudoaneurysms. Venous hypertension was the presenting complication in 26 (10.9%) patients, whereas aneurysmal dilatation, hematoma, and ischemic steal were the presenting complications in 25 (10.5%), 20 (8.4%), and 5 (2.1%) patients, respectively.
Conclusion
Complications of hemodialysis access create significant problems for nephrologists and the healthcare system. Access interventions are often costly, challenging, and may require specialized surgical expertise. Management of complications associated with AV access is an integral part of planning individual hemoaccess procedures.

Introduction
Type 2 diabetes mellitus is known for its morbidity and mortality worldwide. It has been demonstrated in recent studies that abnormal levels of adipocytokines may contribute to insulin resistance and type 2 diabetes.
Objective
The aim of the present study was to assess the relationship between serum leptin levels and insulin resistance syndrome in type 2 diabetic patients.
Patients and methods
A total of 80 individuals were enrolled into this study, and were divided into two groups –20 healthy persons comprised the control group and 60 patients with type 2 diabetes mellitus comprised the disease group. The disease group was further divided into those with evidence of metabolic syndrome (30 patients) and those without (30 patients). Parameters such as age, sex, and anthropometric measures and biochemical indicators such as fasting and postprandial blood sugar, HbA1c, lipid profile, leptin, and fasting insulin were determined.
Results
Higher leptin and insulin levels were observed in patients with metabolic syndrome (P < 0.001).
Conclusion
High serum leptin is a good indicator and can act as a minimally invasive marker for early detection of insulin resistance syndrome.

Introduction
Psoriasis is a T-cell-mediated inflammatory disease where T-helper (Th) lymphocytes (Th1, Th17, and Th22) play an important role in its pathogenesis. The aim of the present study was to assess the serum levels of interleukin (IL)-22 and its correlation with disease severity.
Materials and methods
The present study included 25 psoriatic patients and 25 healthy controls. Using serum samples collected from psoriatic patients and healthy controls, the concentrations of IL-22 were examined using ELISA kits. The severity of psoriatic skin lesions was assessed using psoriasis area and severity index scores.
Results
IL-22 concentrations were significantly higher in psoriatic patients in comparison with the control group. A significant, positive correlation between the concentrations of IL-22 and the severity of psoriasis was found.
Conclusion
The results of our study suggest that Th22 along with its cytokine responses may contribute to the skin and systemic inflammatory conditions characteristic of psoriasis. It seems that early identification of soluble biomarkers and initiation of well-matched treatment may prevent exacerbation and progression of psoriasis.

Introduction
Click auditory brainstem response (ABR) is abrupt, has a rapid onset, and has a broad spectrum nonfrequency-specific response. ABR needs good neural synchrony, i.e., the greater number of neurons that fire results in a larger response amplitude. Recently, it has been suggested that a chirp stimulus may produce a synchronous response from a large portion of basilar membrane. The chirp was designed to produce simultaneous displacement maxima along the cochlear partition by compensating for frequency-dependent traveling time differences.
Material and methods
In this study, we attempt to find a correlation between pure tone threshold (PTA) and each of the click and chirp ABR thresholds in children with moderate and severe sensory neural hearing loss (SNHL).
Results and conclusions
Results show that there is a significant correlation between chirp and behavioral PTA and between click and behavioral PTA in children with normal hearing and hearing impaired but not in those with severe steeping SNHL. In steeping SNHL, there was reduced correlation between behavioral PTA and click ABR stimuli. In addition, there was a significant correlation between narrow band-chirp at 500, 1000 Hz, and 4000 Hz and behavioral PTA in children with normal hearing loss and SNHL but not in those with severe steeping SNHL. In this category, there was a reduction in correlation between behavioral PTA and narrow band-chirp ABR stimuli.

Background
Diabetic macular edema (DME) is the most common cause of loss of vision in diabetic patients. The role of inflammation in the pathogenesis of DME has been demonstrated. An intravitreal (IVT) injection of triamcinolone acetonide (TA) is a treatment option for DME. The high incidence of side effects, however, limits the routine use of IVT TA.
Aim
The aim of this study was to compare the efficacy and safety of an IVT injection of TA with the less invasive posterior subtenon (PST) injection of TA. We test the hypothesis that both techniques have equal efficacy and safety.
Patients and methods
This is prospective randomized noninferiority trial. Totally, 34 eyes from 30 patients with diffuse center involving DME were randomized in a 1: 1 ratio to receive a TA injection by either method. Baseline evaluation included measurement of best-corrected visual acuity (BCVA) and intraocular pressure (IOP), fundus fluorescein angiography, and optical coherence tomography to measure central macular thickness (CMT) and evaluation of the crystalline lens. After the injection, patients were seen at 1 week, 1 month, 3 months, and 6 months and their BCVA, CMT, IOP, and change in these measures from baseline as well as other complications were recorded. A Mann–Whitney U-test was used to compare the mean of quantitative variables and a c2-test was used to compare qualitative variables between the two groups.
Results
At baseline, both groups showed no statistically significant difference in age, sex, IOP, BCVA, and CMT. At 1, 3, and 6 months, both groups showed no statistically significant difference in the mean BCVA as well as change in BCVA from baseline. The average reduction of CMT was significantly higher only in the IVT group at 1 month (P = 0.03). The mean IOP and average IOP change from baseline were significantly higher in the IVT group than the PST group only at 3 months after injection (P = 0.02). Both groups showed a similar incidence of development of cataract (P = 1.0, c2).
Conclusion
IVT injection of TA is more effective than PST injection in improving CMT – that is, anatomical outcome. This is not, however, translated into a superior visual outcome. The risk of IOP elevation is also higher in IVT than PST injection. PST is a valid alternative to an IVT injection, especially from the functional perspective and when the risk of IOP elevation is significant.